"All human beings are born free and equal in dignity and rights"
Vaccines are one of the most effective public health interventions ever invented. They are the only thing thus far that have managed to eradicate one disease (smallpox) and almost eradicate another (polio). As vaccine coverage has increased in both high and low-income countries around the world, incidence of vaccine preventable diseases have declined dramatically.
However, underneath this apparent success is the hidden entrenchment of inequalities. Some people living in certain geographic areas, from specific ethnic groups or religious faiths, recent immigrants and those on low-incomes have lower vaccine uptake and higher risk of catching a communicable disease. This is true in both rich and poor countries. In the majority of cases it appears that routine vaccination programmes cater to the majority, but often fail to provide for certain minority groups. In wealthy countries, this may be new immigrants with low incomes living in urban areas, who’s first language may not be the same as the majority of the country. In poorer countries, this may be new migrants to cities from rural communities, who end up living in poor quality housing in urban slums.
Reducing inequalities in vaccine uptake is essential to reduce communicable disease burden in the most vulnerable communities. In the first of a series of papers on the topic, Sandra Mounier-Jack, Michael Edelstein and I have published a systematic review looking at interventions to reduce vaccine uptake inequalities in children and young people living in high-income countries in the journal BMJ Epidemiology and Community Health.
Interventions that target multiple parts of the vaccination delivery system have evidence for effectiveness and should be used to inform improvements to the routine programme in high-income countries, but also to design better services matched to the needs of under-served communities. Now the challenge is how to get this implemented. There is no time to waste.